In this issue:   

Vol. 9, April 2008

 

Greetings partners,

Welcome to the latest edition of JE Newsbriefs, bringing you updates on the efforts of PATH and partners toward controlling the burden of JE in countries that suffer the greatest impact.

I would like to take this opportunity to recognize the contributions of Dr. Kathy Neuzil, who served as Interim Director of the JE project for nearly a year and recently accepted a new position at PATH to direct a project that will address the risk of pandemic influenza by advancing the development of safe and effective vaccines. Kathy is a world-renowned expert on influenza, and I trust that the leadership she brought to the JE project will ensure success in this new venture.

As the JE project’s director, I look forward to meeting and working with all of you—our instrumental partners and team members throughout the world—and to supporting your important and lifesaving work.

Sincerely,

Dr. John R. Wecker
Director, PATH JE project; Director, PATH Immunization Solutions
jeproject@path.org

 

India aims to vaccinate 20 million more in third year of JE immunization strategy

Building on two successful years introducing live, attenuated JE vaccine in high-risk areas, the Government of India will kick off the third year of its five-year strategy in March. Campaigns in 2008 aim to reach more than 20 million more children and adolescents in 23 districts of 10 states by next August, and PATH will continue to provide technical assistance.

 

Concluding in Bihar this month, outreach through the 2007 campaigns brought vaccines to more than 18 million vulnerable children, with 86 percent coverage of the target population. A particular focus to date has been careful monitoring of adverse events following immunization (AEFI), as use of the SA 14-14-2 vaccine in India began only recently with the 2006 introduction campaigns. At its November 2007 meeting, the World Health Organization (WHO) South-east Asia Regional Working Group on Immunization appreciated the attention that the Government of India paid to monitoring AEFI and felt that the data from these campaigns would help better understand the safety of the SA 14-14-2 vaccine.

 

WHO advisory committee acknowledges safety of coadministering live JE and measles vaccines

Following its review of data from a PATH-sponsored clinical trial among infants in the Philippines, the Global Advisory Committee on Vaccine Safety (GACVS) stated that live, attenuated SA 14-14-2 JE vaccine can safely be administered with measles vaccine at nine months of age. GACVS noted that, although one-month postvaccination immunogenicity data demonstrated some interference with the response to measles vaccine, the impact on seroconversion rates was small. Furthermore, among those who had seroconverted at one month, data at one-year postvaccination showed no differences between infants who received measles vaccine alone and those to whom the vaccines were coadministered. GACVS interpreted this to suggest that the interference seen at one month may have been only temporary and that coadministration is acceptable. Click here to read the full GACVS report, published in the January 25, 2008, issue of the Weekly Epidemiological Record.

 

GACVS encouraged additional study to ensure that measles vaccine effectiveness remains undiminished, and further data are forthcoming. PATH and the Research Institute of Tropical Medicine are continuing long-term follow-up of children in the Philippines study, and another measles-JE vaccine coadministration study is ongoing in Sri Lanka.

 

Partner profile: Epidemiology Unit, Sri Lanka Ministry of Healthcare and Nutrition

The Epidemiology Unit within the Sri Lanka Ministry of Healthcare and Nutrition (MOH) has long been a regional leader in JE disease control. After several JE outbreaks, the Epidemiology Unit introduced inactivated mouse brain-derived vaccine into high-risk areas in 1988. As one of the first programs in the region to introduce inactivated JE vaccine, they have often shared their strategy for JE control with other countries.

Eventually, JE immunization expanded to include children under 10 in 18 high-risk districts. However, increased reports worldwide of adverse events following immunization with the inactivated vaccine and its high cost (nearly three-fourths of Sri Lanka’s vaccine budget) prompted the Epidemiology Unit to consider transitioning to the live, attenuated SA 14-14-2 vaccine.

To provide data for decision-making, the Sri Lanka MOH performed a cost-effectiveness analysis, which included an immunization coverage survey and collection of cost data in select districts. In September 2007, the Epidemiology Unit launched a clinical trial to evaluate the safety and immunogenicity of the SA 14-14-2 JE vaccine among children who previously received doses of the inactivated vaccine. In addition, the trial will evaluate the safety and immunogenicity of coadministering measles and the SA 14-14-2 vaccines. The Epidemiology Unit is optimistic that it will be able to introduce the live JE vaccine in to the Expanded Program on Immunization based on the results of the clinical trial. Results from these activities, conducted in collaboration with PATH, will not only inform next steps in Sri Lanka but also in other countries considering transition from inactivated to live JE vaccine.

 Along with managing Sri Lanka’s immunization program, the Epidemiology Unit conducts disease surveillance; implements control programs for communicable diseases; monitors new, emerging, and re-emerging diseases; and carries out applied research activities on disease control strategies.

 

Upcoming symposium to address achievements and challenges in JE control

Global experts will offer insight on “Controlling Japanese encephalitis: Advances in detection and prevention” at a PATH-sponsored symposium to be held during the 13th International Congress on Infectious Diseases in Kuala Lumpur, Malaysia, on June 22, 2008. The event aims to raise awareness about JE disease burden and control among meeting participants, who represent a broad spectrum of child health in the region and worldwide. Speakers will provide updates on the efforts of PATH and partners to strengthen surveillance and diagnostics, evaluate JE vaccines through clinical trials and cost-effectiveness studies; inform country-level decision-making and advocacy; and assist endemic countries with vaccine introduction and control strategies. Participation is open to congress attendees only. Click here for registration information.

Cohort study assesses WHO JE surveillance standards

The March 2008 issue of the Bulletin of the WHO features an evaluation of the WHO field test version of standards for JE surveillance, conducted by a team from the University of Liverpool. Researchers studied the sensitivity and specificity of the WHO case definition for acute encephalitis syndrome, which the standards use as the basis of JE surveillance, among an existing cohort of patients with suspected central nervous system infections in southern Viet Nam. The case definition identified JE-virus infected children with neurological disease with a sensitivity of 65 percent and specificity of 39 percent. Adding limb paralysis and meningism to the definition would have identified 53 of 54 JE-virus infected children, though specificity declined. Among adults, the definition was 100 percent sensitive, but specificity was only 16 percent. The study also evaluated the case definition's laboratory criteria. According to lead investigator Professor Tom Solomon, “This study shows the usefulness of the surveillance standards in this setting but it will be important to repeat the assessment in other parts of Asia.” For detailed results, click here.

 

US, Australia, and European Union agencies considering licensure of Intercell vaccine for adult use

Intercell recently announced the submission of licensure applications to the US Food and Drug Administration, the European Medicines Agency, and the Australian Therapeutic Goods Administration for its inactivated vaccine against JE. The initial target for use of Intercell's vaccine will be adults and military personnel traveling to endemic countries. In partnership with Biological E, Intercell launched a pediatric Phase 2 clinical trial in India last July to study safety and immunogenicity among children between one and three years old.

 

Who's who at the PATH JE project: Ginger Topel

If a unique collaboration brings together team members and external partners toward a shared outcome, chances are Ginger Topel played a role in it. As lead administrator, Ginger is a hands-on communicator and facilitates partnerships to benefit many of the JE project’s activities. Internally, her information updates help the team stay up to speed on each other’s accomplishments and allow for pivotal contributions to address challenges. Externally, Ginger closely supervises partner contracts and budgets to make sure milestones are met and deliverables received. Her responsibilities also extend beyond collaborations to inform project strategy and implementation.

Bringing team members together to solve problems and achieve results, Ginger says, is the most rewarding part of her job. She draws on experience working with a variety of immunization experts on the PATH Children’s Vaccine Program, for which she served as the primary administrator on various projects that emphasized cross-program links, including close collaboration with PATH’s Technology Solutions program.

Ginger’s work in international affairs grew from her fluency in Spanish, which she first applied as an administrator of educational programs for foreign students at the University of California, Davis. A friendship struck up with Guatemalan health care workers enrolled in the program inspired Ginger to travel to their country, where rural conditions and a different way of life “truly opened my eyes,” she says. When she joined PATH, this perspective—along with experience she was quickly gaining in program administration—made Ginger a perfect fit for a working group to develop PATH’s presence in Latin America. Today, after nearly ten years at PATH, she has seen the organization develop in many ways, including immunization expertise that is instrumental to the success of programs like the JE project.

 

JE resources


JE project web page   
www.path.org/je

JE on PATH’s Vaccine Resource Library
www.path.org/vaccineresources/japanese_encephalitis.php  

Japanese encephalitis online training module (AIM series)
http://aim.path.org/en/vaccines/je/index.html

 

JE films: Kill or cure? Japanese encephalitis and Shadow lives: The human toll of Japanese encephalitis

www.path.org/vaccineresources/japanese_encephalitis-films.php

WHO Position Paper on JE

www.path.org/vaccineresources/files/WHO_JE_position_paper_2006.pdf

 

Masthead photo: Richard Lord